Arrhythmias and conduction disturbancesAtrial fibrillation after beating heart surgery
Section snippets
Patients
All patients (n = 12,364) who underwent CABG at the Washington Hospital Center between January 1987 and May 1999 were identified using the computerized database system of the Department of Cardiac Surgery. Of these, 993 (8%) underwent off-pump CABG. Patients with preoperative AF (n = 15) were excluded, as were patients who initially underwent operation off-pump and who had to be converted to a standard on-pump procedure (n = 9). Thus, our study population comprised 969 patients with normal
Results
During the study period, 206 of the 969 patients (21%) who underwent off-pump CABG developed postoperative AF. The mean AF rate throughout the study period remained constant throughout the period of study (0.22 ± 0.1). Baseline clinical and demographic characteristics are summarized in Table I. Patients who developed AF were more likely to be older and to have type 1 (insulin-dependent) diabetes, ejection fraction <34%, multivessel disease, or previous stroke than did patients without AF.
Discussion
AF is a common complication after open cardiac procedures and its incidence has been reported to vary between 3.1% and 30%,1, 2, 3, 7 compared with 1.8% in the general population.12, 13 Different mechanisms have been proposed to explain the high incidence of AF after cardiac surgery, including withdrawal of β blockers administered preoperatively14; structural changes in the heart such as those related to age, the effects of cardiopulmonary bypass, and cardioplegia, as well as the effects of
Acknowledgements
We are indebted to Ellen Shair for her editorial contribution to this manuscript.
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